By: Darryl Jamison

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OB/GYN EMERGENCIES

• By Darryl Jamison
• Macon County EMS Training Coordinator

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Objectives

• Describe fetal-maternal blood flow and the role
  of the placenta.
• Identify the details of the history that should
  be obtained from an obstetrical patient.
• Discuss the effects of pregnancy on pre-existing
  conditions such as diabetes, HTN, and cardiac
  problems.
• Define the following terms
• Spontaneous abortion criminal abortion
  therapeutic abortion

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Objectives cont

• Describe the pathophysiology and management of
  the following conditions
• Ectopic pregnancy
• Abruptio placenta
• Placenta previa

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Objectives cont.

• Distinguish between pregnancy-induced
  hypertension, preeclampsia, eclampsia.
• Describe management of prolapsed cord.
• Describe management of breech presentation
• Describe management of multiple-birth
  presentation
• Describe the pathophysiology and management of
  the following conditions
• Postpartum hemorrhage
• Uterine inversion
• Uterine rupture

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Fetal-Maternal Blood flow

• Blood flows from the placenta in through the
  umbilical vein which connects to the inferior
  vena cava then to the heart
• Routed around the lungs through the ductus
  arteriosus, into the aorta and then throughout
  the baby.
• Deoxygenated blood is filtered by the liver and
  then transported to the mother

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Role of the placenta

• Provides for exchange of respiratory gases.
• Transport of the nutrients
• Excretion of wastes
• Transfer of heat
• The placenta becomes an active endocrine gland,
  producing several important hormones

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History

• Should include
• Graviditynumber of pregnancies
• Paranumber of viable fetus delivered
• Length of gestation
• Estimated date of confinement
• Previous complications with pregnancies

• When did pain start
• Sudden or slow in onset
• Duration, location, radiation
• Is it regular
• Spotting
• Proper prenatal care
• If active labor, question push or bowel movement

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Diabetes

• Patients have to be placed on insulinmedication
  will pass to the fetus
• Effects on babytend to be larger in size
• Tend to have trouble maintaining body temp. And
  subject to hypoglycemia

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Hypertension

• Generally speaking bp is lower in pregnancy than
  non-pregnancy
• Preexisting hypertension is exacerbated
• Persistent HTN adversely affects placental size
• Leading to compromise of fetus and placing mother
  at risk for CVA or renal failure

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Cardiac

• During pregnancy, cardiac output increases up to
  30
• Can lead to CHF from preexisting

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Spontaneous Abortion

• Commonly called a miscarriage
• Occurs of its own accord
• Occur before the 12th week of pregnancy
• Many occur within 2 weeks after conception, being
  mistaken for menstrual cycle

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Criminal Abortion

• Attempt to destroy fetus by one whom is not
  licensed to do so
• Amateurs
• Without aseptic techniques
• Leads to other complications

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Therapeutic Abortion

• The pregnancy posed a threat to maternal
  well-being
• Judged to medically indicated

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Ectopic Pregnancy

• Pathophysiology
• Implantation of fertilized ovum outside of the
  uterus.
• Approximately 1200
• Most common sitefallopian tube
• Truly a medical emergency
• Causes extensive bleeding into the abdominal
  cavity and pelvis

• Predisposing factors
• Previous pelvic infections
• Pelvic adhesionsprevious abdominal surgery
• Tubal ligations
• IUD

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Assessment of ectopic pregnancy

• At risk for rapid development of shock
• Take VS frequently
• Abdominalsignificant lower quadrant tenderness
• Avoid as much as possible?rupture of ectopic
• Bleeding can range from spotting ? profuse

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Management

• Difficult to diagnose
• If suspected should care for as any shocky
  patient
• Emergent transport

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Abruptio Placenta

• Third trimester bleeding
• Premature separation of the placenta from the
  uterine wall.
• Partial or complete
• Complete often results in death of fetus

• Predisposing factors
• Preeclampsia
• Maternal HTN
• Multiparity
• Abdominal trauma
• Extremely short umbilical cord
• Vaginal blood loss is minimal due to blood
  collecting behind placenta

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Assessment

• Have constant, severe abdominal pain
• Feels like something is tearing
• Abdomen is very tender
• Bleeding will be dark in color
• PMHabruptio placenta

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Management

• COMI
• Large bore IVs
• Rapid transport

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Placenta Previa

• Attachment of the placenta that partially or
  completely covers the internal cervix
• Begins to bleed as the cervix thins out,
  spreading the placenta until it tears
• Precipitated by sexual intercourse or digital
  vaginal examination

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Assessment

• Usually multigravida
• Third trimester
• Most commonpainless, bright red bleeding
• Uterus is soft

• Management
• COMI
• High flow O2
• Large bore IVs
• Rapid transport

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PIH

• Bp of 140/90
• Early stage of disease process
• Bp is normally low so 130/80 maybe high

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Preeclampsia

• Characterized by
• HTN
• Abnormal weight gain
• Edema
• Headache
• Protein in urine
• Epigastric pain
• Visual disturbances

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Eclampsia

• Characterized by the same as pre but includes
  seizures

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Supine Hypotensive Syndrome

• Occurs in the third trimester
• Marked decrease in blood flow to the heart due to
  increase mass in abdominal cavity
• Compresses on the inferior vena cava thus
  decreasing the blood flow back to the heart

• Assessmentbe aware of signs of shock and verify
  previous problems with same
• Managementplace in LLR, treat for shock if other
  signs of shock are present.